We know many doctors have less time to visit with each patient. Still, most patients say that if their doctor told them to be more physically active, they would listen. Doctors need to ask questions at every visit about what kinds of activity and how much activity each patient is getting. If doctors don't have time to counsel, they can refer patients to other healthcare team members. These may include nurse case managers, certified exercise professionals trained in behavior-change programs and sports nutritionists.

Who should be screened before starting an exercise program?

Doctors should screen all patients with a history of cardiovascular disease or who are at high risk of a heart attack or stroke before they start a vigorous exercise program. People who are obese, have diabetes or other serious medical problems, or who have been sedentary for a long time should talk to their doctor before starting any exercise program. The American Heart Association has published guidelines for exercise testing, exercise pre-competition screening for both young and older (Masters) athletes, as well as screening guidelines for health and fitness club facilities.

All counseling programs should evaluate each patient's risk for a heart attack, stroke and such problems as diabetes, osteoporosis and arthritis. A doctor can use this information to develop guidelines and start patients on an individualized activity program. Counseling programs should be customized to reflect gender, age and cultural factors. Identifying the kinds of activities that each person enjoys is important to help ensure that they maintain an active lifestyle for a lifetime.

What approaches are effective in exercise counseling?

Doctors can increase the likelihood that patients will become more active just by writing general information such as "walk for 30 minutes on most days of the week" on a prescription pad. They can place color-coded stickers in patients' charts as reminders to follow up at the next visit or to ask one of their staff to make a follow-up call within two weeks after the patient's visit. They can also refer patients to American Heart Association programs such as Start! and Choose To Move. Patients can buy self-care programs such as the American Heart Association Healthy Heart Walking CD.

At the start of each program, patients should set long- and short-term goals. Doctors and other healthcare professionals need to identify

• patients' barriers to becoming more active
• people who will offer social support
• a reward system that will help motivate each person

If people don't have a full 30 minutes for activity, encourage them to find 10- to 15-minute periods throughout the day where they can go for a brisk walk (such as walking the dog in the morning, at lunchtime or after dinner).

Sedentary people need to gradually build up to 30 minutes with moderate-intensity activities like brisk walking. They can start with 10–15-minute sessions 3–4 times the first week, then add five minutes to each session each week until they build up to at least 30 minutes. If they need to lose weight, they may need to work up to 45–60 minutes. As people become fitter, they can increase the intensity of their activity.

Related AHA publications

• Just Move! (also in Spanish)
• Walking for a Healthy Heart 
• "How Can Physical Activity Become a Way of Life?" in Answers By Heart kit (also in Spanish kit)
• "Why Should I Exercise?" and "How Can I Keep Track of Exercise and Eating?" in Answers By Heart kit

Related AHA Scientific Statements:
Physical Activity